MR Modules

BODY BASIC
• Liver
• Pancreas
• MRCP
• Kidneys
• Pelvis
• Prostate
• Bowel
 BODY BASIC
• Coils
• Introduction :
 Liver protocol
 Pancreas protocol
 MRCP protocol
 Kidneys protocol
 Pelvis protocol
 Bowel protocol
• Sequences for all protocols
BODY BASIC LAVA LAVA-XV LAVA-Flex 3D Dual echo FS FIESTA FIESTA T2 FRFSE T2 SSFSE DWI 3D FRFSE
Liver x x x x x x x x x
Pancreas x x x x x x x x
MRCP x x x x x x x
Kidneys x x x x x x x
Pelvis x x x x x
Bowel x x x x x

• Prostate Imaging
• Bowel protocol
 Body MRI
Coils

Profile Ovation Brivo 355 Optima 360 Hde Hdi

4-ch Torso Phased Array Coils x x x
8-ch HD Torso array x x x
8-12 channel HD Body array x x
Endorectal interface device

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
4-ch HD Torso/Body array
8-ch HD Torso array x x x x
8-12 channel HD Body array x x x x x
Endorectal interface device x x
 Body MRI
Coil :
Torso Phased Array Coils
• 4 channel, 4-element
• 4-channel Linear Receive Phased Array
design (Receive – only coil)
• 4-elements are arranged with 2 overlapping
elements in the anterior coil set and 2 in the
posterior
• Sensitive imaging volume : 34 cm wide x 32
cm long coverage of the chest, abdomen, and
pelvis
• Compatible with parallel imaging
• Compatible with ATD-T for endo-cavitary
imaging
• 18 x 2 x 16 in
• Manufactured : GE coils
 Body MRI
Coil :
HD torso array

• 8 channels
• 8-element phased array design
• Compatible with parallel imaging
• 40 cm S-I coverage
• Coil dimensions : 110 x 38 x 33 cm (43 x
15 x 13 in)
• Manufactured : GE Coils
 Body MRI
Coil :

HD body array : 8-12 channel

• 8 channel, 12 element
• Receive-only coil
• Compatible with parallel imaging
• 48 cm S-I coverage
• 31 x 4.5 x 21.5 in
• Manufactured : GE coils
 Body MRI
Coil :
8-12 channel HD body array

• Upper : 8 channels for abdominal imaging

• Lower : 8 channels for pelvic imaging
• Full : 12 channels for complete coverage
• Higher acceleration factors are possible with LAVA-
XV

33cm
48cm
FOV
33cm FOV
FOV
 Body MRI
Coil :
32-Ch Torso – WIP : abdominal imaging

The new 32-channel torso coil is

particularly useful with the Discovery
MR750 scanner and 3D pulse sequence,
LAVA-Flex. This technique produces four
images for each slice location. By using
the coil in conjunction with the new
parallel imaging algorithm, ARC,
abdominal studies that were previously
unattainable can now be accomplished
with a single breath hold
 Body MRI
Coil :
Endorectal coil (Endorectal array)

• ATD-T allows combination of endorectal coil with 8

or 12-channel body array
• Prostate imaging and spectroscopy
• Compatible with HD Body array
• Not compatible with parallel imaging
• Coil dimensions : 18 x 18 x 9 in (45 x 45 x 22 cm)
• Manufactured : MedRad
 Body MRI
Introduction :
 Liver protocol
 Pancreas protocol
 MRCP protocol
 Kidneys protocol
 Pelvis protocol
 Bowel protocol
 Body MRI : Introduction
Liver protocol :
LAVA
LAVA-Flex
3D Dual echo (TE Out, TE In)
FIESTA Fatsat
T2 FRFSE
T2 SSFSE
DWI
 Body MRI : Introduction
Pancreas protocol :
T2 SSFSE
T2 FRFSE
FIESTA fatsat
LAVA with/without gado
 Body MRI : Introduction
Biliary ductal protocol :
T2 SSFSE
3D FRFSE
FIESTA fatsat
LAVA with/without gado
 Body MRI : Introduction
Kidneys protocol :
T2 SSFSE
FS FIESTA
LAVA with/without gado
 Body MRI : Introduction
Pelvis protocol :
T2 FSE
T1 FSE
T1 FSPGR
LAVA
Cube
Prostate protocol :
T2 FRFSE
DWI
LAVA
 Body MRI : Introduction
Bowel protocol :
T2 SSFSE
T2/T1 FIESTA
LAVA
 Body MRI
Sequences for all protocols
BODY BASIC LAVA LAVA-XV LAVA-Flex 3D Dual echo FS FIESTA
Liver x x x x x
Pancreas x x x x
MRCP x x x x
Kidneys x x x x x
Pelvis x x x
Bowel x x x

BODY BASIC FIESTA T2 FRFSE T2 SSFSE DWI 3D FRFSE

Liver x x x x
Pancreas x x x x
MRCP x x x
Kidneys x x
Pelvis x x
Bowel x x
 Body MRI
LAVA : Liver Acquisition Volume Acceleration
Target :
• To study contrast uptake dynamics in the abdomen

Characteristics :
• T1 Weighted 3D Fast Spoiled Gradient Echo
• Fat suppression using Extra SPECIAL
• Multi-phase imaging using short TR/TE and short RF duration with a sharp slab
profile (inducing less slice wrapped even when ASSET is applied)
• Large coverage using data interpolation of 25% in the slice encoding direction
(Partial Kz : No alteration of the in-plane spatial resolution despite interpolation)
• ASSET acceleration (with calibration scan)
 Body MRI
LAVA : Liver Acquisition Volume Acceleration
Characteristics :

° °
RF
S3
G Slice
S1 S2
P1
G Phase
R2
G Read
R1
Time
 Body MRI
Characteristics :
• Extra SPECIAL : Spectral Inversion at Lipids
 Selective RF will flip the magnetization of the fat protons
 Inversion flip angle of 180° apply to a segment of Kz lines (long TI)
 The imaging sequence just begins before the TI
 Sequential K-space view ordering : improves scan time efficiency and
eliminates slice-to-slice contrast variation
 The TI is not selectable

Mz
Null Point of Fat
Fat Signal

Slice Encodes
 Body MRI
Characteristics :
• LAVA with injection :
 Gadolinium enhanced T1 weighted
 Multi-phase : 3 acquisitions are repeated
 Arterial phase
 Portal phase
 Post equilibrium phase
 Hepatic arterial-phase MRI plays an important role in detecting
hypervascular tumors
 Body MRI
Acquisition Images without injection
 Body MRI
Acquisition Images with injection

Washout

Arterial phase Portal phase Post equilibrium phase

Arterial perfusion Contrast uptake

Dynamics
Portal systemc

Liver veins

Liver parenchyma
 Body MRI
Acquisition Images : parameters
Patient position : Supine Shim : Auto
Coil : 8Ch Body Upper Phase correction : No
Plane : Oblique Contrast : Yes/No
Pulse sequence : LAVA Sat saturation : SPECIAL
Mode : 3D Imaging options : Fast, ZIP x2, ZIP x512, ASSET,
Multi phase
Flip angle : 12
ASSET :
TE : NA
Slice Acceleration factor : 1.0
TR : NA
Phase Acceleration factor : 2.0
Bandwidth : 83.33
Multi-Phase :
FOV : 46
# of Acquisition : 0
Slice thickness : 3.8
# of Phases : 4
Location per slab : 50
Separate Series : 1
Freq : 260
Delay after Acquisistion without AV : 10
Phase : 260
Trigger delay without AV : 0
Freq DIR : R/L
Mask Phase : 1
Phase FOV : 0.90
Mask Pause : 1
 Body MRI
LAVA : Advantages & Clinical Benefits
• It enables the high-quality 3D MR imaging of the liver during short breath-
holding periods (The Partial Kz filling technique results in faster scan times)
• Large anatomical coverage at a speed unmatched by standard MR
• Improved differentiation between HCC (“corona” enhancement in the late
hepatic arterial phase) and other lesions
• High in-plane spatial resolution
• Unprecedented soft tissue contrast due to excellent fat suppression (Extra
SPECIAL)
• High quality reformat images (MIP, Min IP)
• Assessment of proximity of lesions to vascular structures
 Presurgical vascular mapping
• High sensitivity to detect small lesions (< 0.50 mm)
 Body MRI
LAVA : Challenges & Limitations
• Less spatial resolution along S-I
• Longer breath-hold when extended S-I coverage needed
• Risk of inconsistent organ localization due to un-even successive breath-holds
• Risk of slice-encoding phase artifacts along S-I, propagating from slice to slice
 Body MRI
LAVA : Clinical Use
 Liver :
• Diffuse Liver Diseases : Cyrrhotic liver
 Characterization and Grading
• Focal liver lesions : Hepatic abcesses
 Detection and Characterization
• Key information for the therapeutic strategy and preoperative planning :
 Reference to segmental anatomy
 Delineation of relationship of vascular, biliary, and abdominal
structures
• 3D Presurgical vascular mapping
 Body MRI
LAVA : Clinical Use
 Pancreas :
• Evaluation of the :
 Intra and extra pancreatic ducts : Intraductal papillary-muscinous
tumor
 pancreatic parenchyma : Extrapancreatic or inflammatory process
 adjacent soft tissues
 vascular network : Vascular presurgical mapping
 Kidneys :
• To study kidneys parenchyma and the renal arteries
• Pediatric patients with renal dysfunction
• Kidney transplant
 Body MRI
LAVA : Clinical Use
 Pelvis :
• Anorectal fistula
• Cervix cancer
• Rectal oedema
• Detection and characterization prostate cancer :
 Adenoma : benign hypertrophy
 Adenocarcinoma : 90% of cancers
 Bowel :
• Crohns disease
• Detection and characterisation stromal Tumor (LAVA Minip : Multiple
tumoral nodules = massive contrast uptake at the arterial phase)
 Body MRI at 3T
LAVA : System Compatibility & Options
• Options :
 Acceleration type : ASSET
 Maximum acceleration : x2
 Fast, ZIP x2, ZIP x512, Multi phase
• Possibility of reformatting images : Min IP, and MIP
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

LAVA No No Yes yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
LAVA Yes Yes Yes Yes Yes
 Body MRI
LAVA-XV : eXtended Volume
Target :
• To study contrast uptake dynamics in the abdomen with parralel imaging
technique called GEM (General Encoding Matrix) or ARC

Characteristics :
• LAVA + GEM
• GEM : is Self-calibrated with variable density sampling and full center k-space
acquisition
• LAVA-XV incorporates both acceleration in the phase and slice direction
• All data used in reconstruction : High SNR
• Phase FOV and small FOV compatibility
• Flexible k-space sampling schemes
• Hybrid reconstruction
• XV : usually indicates some type of parallel imaging enablement
 Body MRI
LAVA-XV :
Characteristics :
• 2D acceleration : skip data along two k-space dimensions
 Higher acceleration factors possible (R >4)
 Rtotal = Rky * R kz = 2 x 2 = 4
R=3

Phase Encode
R=2
Kz
g’ Self Cal
g
Ky
 Body MRI
Acquisition Images

Lava XV MIP Lava XV MIP Lava XV min-IP

 Body MRI
Acquisition Images
 Body MRI
Acquisition Images : parameters
Patient position : Supine Freq DIR : S/I
Plane : Oblique Phase FOV : 0.90
Pulse sequence : LAVA-XV Shim : Auto
Mode : 3D Phase correction : No
Flip angle : 12 Contrast : Yes
TE : NA Sat saturation : SPECIAL
TR : NA Imaging options : EDR, Fast, ZIP x2, MP
Bandwidth : 100 Multi-Phase :
FOV : 44 # of Acquisition : 0
Slice thickness : 3.6 # of Phases : 3
Location per slab : 42 Separate Series : 0
Freq : 416 Mask Phase : 1
Phase : 352 Mask Pause : 1
 Body MRI
LAVA-XV : Advantages & Clinical Benefits
• LAVA-XV acquires a 3D high resolution volume of the entire abdomen in one
breathold (due to GEM)
• Higher SNR : all data used in reconstruction in comparison to LAVA
• Reformat native axial or coronal slices in any plane (thanks to the high
resolution 3D acquisition) to see the anatomy/lesions from a different
perspective
• Faster imaging in comparison to LAVA
• No artifacts from mismatched breath-holds
• Flexible k-space sampling schemes
 Body MRI
LAVA-XV : Challenges & Limitations
• Less spatial resolution along S-I
• Longer breath-hold when extended S-I coverage needed
• Risk of inconsistent organ localization due to un-even successive breath-holds
• Risk of slice-encoding phase artifacts along S-I, propagating from slice to slice
 Body MRI at 3T
LAVA-XV : System Compatibility & Options
• Options :
 Acceleration type : GEM
 Maximum acceleration : x2
 EDR, Fast, ZIP x2, MP
• Possibility of reformatting images : Min IP, and MIP
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

LAVA-XV No No No Yes No No

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
LAVA-XV Yes Yes Yes Yes Yes
 Body MRI
LAVA-Flex :
Target :
• Provides volumetric abdominal imaging with short breath-hold periods and
clear tissue contrast, with water-only and fat-only separation (4 contrasts in 1
scan)

Characteristics :
• LAVA-flex : LAVA sequence with MEDAL acquisition technique (MEDAL = Multi-
Echo for Decomposition of Aqua/Lipid)
• Employed 2-points Dixon reconstruction to generate water-only and fat-only
images
• LAVA-flex delivers 4 bilateral breast 3D images per acquisition :
 water-only,
 fat-only,
 in-phase
 out-of phase images
 Body MRI
LAVA-Flex :
Characteristics :
• Flex separates fat from water based on chemical shift : don’t suppress fat
 No suppression pulse
 Reduction in repeat scans
 Elimination of a separate non fatsat scan
• Acquired both In-phase and out-of-phase echo in the same TR
• Reconstruction : collects two echoes with water and fat, spins in and out of
phase and uses two point dixon techniques to synthesize water and fat images
 Body MRI
LAVA-Flex :
Characteristics :

° °
RF
S4 S1
S6
G Slice S3 S5
S1 S2

G Phase P2
P1
R2
R4
G Read R3

R1
Time

TR
 Body MRI
LAVA-Flex :
Characteristics : Reconstruction
Variables
IP OP IP : In-phase image
OP : Out-of-phase image
0 : Phase of IP due to field inhomogeneity
Phase removal &
 : Phase accumulated due to B0 field
Sum across coils inhomogeneity between 1st and 2nd echo
W: Water image
Known: IP, OP, 0 F: Fat image
Equations
2D Region Growing IP = (W + F) e 0
OP = (W – F) e( 0 -  )
Known: 
IP = IP e - 0 = W + F
Identification & Separation OP = OP e - 0 = (W – F) e ()
e - 0 = |IP| / IP
W F e -  = +/- OP / | OP |
 Body MRI
Acquisition Images

water fat

• 4 contrasts in 1 scan : acquire

In phase and Out of phase
echoes in the same TR
IP OP
 Body MRI
Acquisition Images : Axial

Water Fat
 Body MRI
Acquisition Images : Axial

In phase Out-of-phase
 Body MRI
Acquisition Images : Coronal

Water Fat
 Body MRI
Acquisition Images : Coronal

In phase Out-of-phase
 Body MRI
Acquisition Images : parameters
Patient position : Supine Freq DIR : R/L
Plane : Axial NEX : 1.0
Pulse sequence : LAVA-flex Phase FOV : 0.80
Mode : 3D Shim : Auto
Flip angle : 12 Phase correction : No
TE : NA Contrast : No
TR : NA Imaging options : EDR, Fast, MP, ZIP x2, ARC
Bandwidth : 83.3 MULTI PHASE
FOV : 40 Slice per location : 3
Slice thickness : 4.4 Delay after Acquisition : Minimum
Locations per Slab : 48 # of Acquisition : 0
Overlap locations : 0 Separate series : 0
Freq : 320 Mask Phase : 0
Phase : 192 Mask Pause : 0
 Body MRI
LAVA-Flex : Advantages & Clinical Benefits
• Robust and efficient T1W imaging (equivalent fat-suppressed)
• Higher SNR and CNR than standard LAVA
• Less sensitive to field inhomogeneities
• The ‘water only’ image offers :
 Superior fat suppression over more common techniques
 Better (high) T1 contrast and better (high) SNR on the pre contrast serie,
compared to standard LAVA/LAVA-XV
• The ‘fat only’ image offers :
 For diffuse, focal or geographic steatosis hepatis
 Fat containing lesions : hepatic or adrenal adenoma, angiomyolipoma
• Cyrhotic liver : Better visualization of the regenerative nodules on LAVA-Flex,
compared to LAVA-XV pre contrast
 Body MRI
LAVA-Flex : Challenges & Limitations
• Less spatial resolution along S-I
• Longer breath-hold when extended S-I coverage needed
• Risk of inconsistent organ localization due to un-even successive breath-
holds
• Risk of slice-encoding phase artifacts along S-I, propagating from slice to
slice
• Images labeled as water may include signal from fatty tissue, and images
labeled as fat may include signal from water :
 This error may occur in regions of high magnetic field variation, in
spatially isolated tissue, due to patient or tissue motion, due to phase
wrap artifacts, and/or in images with low signal-to-noise ratios
 Proper calibration and center frequency selection will reduce the
occurrence of this error
 Body MRI
LAVA-Flex : Clinical Use
• Chronic hepatitis
• Detection and characterization Polyadenomous
• Detection and characterization steatosis hepatis (diffuse or focal)
• Cyrhotic liver
• Post-surgery (because metallic artifact is not a problem)
 Body MRI at 3T
LAVA-flex : System Compatibility & Options
• Options :
 Acceleration type : ARC, and ASSET
 Maximum acceleration : x2
• Possibility of reformatting images : Min IP, MIP
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

LAVA-flex No No No No No No

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
LAVA-flex No Yes Yes No Yes
 Body MRI
3D Dual Echo : GRE technique
Target :
• To produce in phase and out of phase images in a single breath-hold

Characteristics :
• 3D FSPGR sequence : gradient-echo technique
• Phase Shift T1 weighted GRE Sequence
• TE in phase : signals add up
• TE out of phase : signal cancellation if fat and water are in the same voxel
• The chemical shift artifacts appearing on the out-of-phase image allows for
the detection of lipids in the liver or adrenal gland
 Diffuse fatty infiltration
 Focal fatty infiltration
 Body MRI
3D Dual Echo
Characteristics :
• This sequence allows the acquisition of the first opposed-phase and the first
in-phase image
• The two echo times match the times at which fat and water are out of phase
(2.2 ms) and in phase (4.4 ms)

0 msec 4.4 msec

« In phase » « In phase »

2.2 msec 6.6 msec

« Out of phase » « Out of phase »

 Body MRI
3D Dual Echo
Characteristics :
• Hydrogen attached to oxygen, as in water, experiences a magnetic field that is
slightly different from that of hydrogen bonded to carbon in fat, inducing a
frequency shift of 220Hz at 1.5T (between fat and water)

fat

water

• Fat and water go in and out of phase with each other approximately every 2.1
- 2.3 ms
 This phenomenon is more apparent at shorter echo times due to
decreased T1 dephasing
 Body MRI
3D Dual Echo
Characteristics :
° °
RF
S3
G Slice
S1 S2
P1
G Phase
R2
G Read R3

R1
Time

TE OP

TE IN
 Body MRI
Acquisition Images
• Acquires two sets of images within a single breath-hold to capture both in-
and out-of-phase TEs

TE In TE Out
 Body MRI
Acquisition Images

TE Out TE In
 Body MRI
Acquisition Images : parameters

Patient position : Supine FOV : 42

Coil : 8Ch Body Upper
Plane : Axial
Pulse sequence : SPGR
Mode : 3D
Flip angle : 12
Number of echoes : 2
TE : Minfull (NA)
TR : Minimum (NA)
Bandwidth : 83.33
Slice thickness : 4.0
Location per slab : 48
Freq : 320
Phase : 192
Freq DIR : R/L
Phase FOV : 0.80
Shim : Auto
Phase correction : No
Imaging options : EDR, Fast, ZIP x2, ARC
 Body MRI
3D Dual Echo : Advantages & Clinical Benefits
• Reduces breath-hold failures and slice mismatches (Acquires images in one
breath-hold due to acceleration with ARC)
• Eliminates interslice gaps for uncompromised small lesion detection and
visualization
• Minimizes partial volume effects and motion artifacts
• Increases SNR compared to 2D technique for higher spatial resolution
• The improved SNR of the 3D acquisition permits thinner slices than those
traditionally available using 2D techniques
• Shortens scan times for critically ill patients
• Performs multi-planar reformats and reconstructions with flexibility
 Body MRI
3D Dual Echo : Challenges & Limitations
• The parameters are few flexible (All parameters are dependent on breath-
hold)
• Slice thickness must be high otherwise the acquisition time increases
 Body MRI
3D Dual Echo : Clinical Use
• Adrenal lesions
• Hepatic lesions : hepatic steatosis
• Assessing fat in the liver or adrenal gland to determine the presence of
disease
• Detection and characterization focal or diffuse fatty infiltration
 Body MRI at 3T
3D Dual echo : System Compatibility & Options
• Coils compatible :
 Body coil (only available if ARC is no part of the protocol)
 8-channel torso PA
 8-channel body array coil
 12-channel body array coil
 8-channel cardiac coil
• Options :
 Acceleration type : ASSET, and ARC
 Maximum acceleration : x2
 EDR, Fast, ZIP x2, ZIP 512
 Body MRI at 3T
3D Dual echo : System Compatibility & Options
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

2D IP-OP
IP-TE 4,6 4,6 4,6 4,6
OP-TE 2,3 2,3 2,3 2,3
3D Dual Echo
IP-TE 4,6 4,6 4,6 4,6
OP-TE 2,3 2,3 2,3 2,3

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
2D IP-OP
IP-TE 4,6 4,6 4,6 3,3 3,3
OP-TE 2,3 2,3 2,3 2,2 2,2
3D Dual Echo
IP-TE 4,6 4,6 4,6 2,2 2,2
OP-TE 2,3 2,3 2,3 1,1 1,1
 Body MRI
FS-FIESTA : Fast Imaging Employing steady
State Acquisition
Target :
• To provide images of fluid filled structures with very short acquisition times

Characteristics :
• Balanced gradient echo sequence
• Fully balanced steady-state imaging pulse sequence designed to maintain
coherent transverse magnetization
• Short TR/TE :
 Short TR : to maintain the steady state
• SSFP T2/T1 contrast
• Accentuates the contrast of water-filled areas such as cysts or bile and
pancreatic ducts and digestive tract
 Body MRI
FS-FIESTA :
Characteristics :
• Inversion pulse at the resonant frequency of fat (Special)
• ASSET (fast scanning)

Signal
T2/T1
T1

T2*

Time
 Body MRI
FS-FIESTA :
Characteristics :

° °
RF
S4
S3 S5 S6
G Slice
S1 S2 S7 S8
P1
G Phase
R2 P2
G Read R3

R1
Time
SSFP FID
TE

TR
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images : parameters
Patient position : Supine Freq : 356
Coil : 8Ch Body Upper Phase : 256
Plane : Axial Freq DIR : R/L
Pulse sequence : Fiesta Nex : 1
Mode : 2D Phase FOV : 1
Flip angle : 50 Shim : auto
TE : Minfull Phase correction : No
Number of echoes : 1 Fat Saturation : Special
Bandwidth : 62.50 Imaging options : Seq, EDR, Fast, ZIP x512, ASSET
FOV : 40 ASSET
Slice thickness : 6.0 Slice acceleration factor : 1.0
Slice spacing : 1.0 Phase acceleration factor : 2.0
 Body MRI
FS FIESTA : Advantages & Clinical Benefits
• The advantages of FIESTA can only be realized with a very short TR
• FIESTA accentuates the signal from tissues that have a long T2 and short T1
• FIESTA is of considerable value in patients who have difficulty with breath
holding
• FIESTA is less susceptible to respiratory motion artifacts compared to T2-
weighted fast spin-echo (FSE) or SSFSE sequences
• Accentuates the contrast of water-filled areas
• Insensitivity to flow artifacts
• Fat suppression :
 Improves the conspicuity of the pancreatic parenchyma and pancreatic
masses
 Facilitates the depiction of hyperintense hemorrhagic peripancreatic
collections against a background of hypointense peripancreatic fat
• Slices are acquired sequentially and cross-talk is not a problem
 Body MRI
FS FIESTA : Challenges & Limitations
• 2D fat SAT FIESTA is particularly sensitive to shim variations, therefore it is
always recommended to place a shim volume during the graphic prescription
process
• Fat suppression may reduce the visibility of stranding within the
peripancreatic fat
• The FIESTA sequence becomes SAR limited when the Flip Angle ≥ 50°,
resulting in a longer TR
 Body MRI
FS FIESTA : Clinical Use
• To study the contrast of water-filled areas : cysts, bile, pancreatic ducts and
digestive tract
• Overview the abdominal vasculature without injection (portal and systemic
venous system)
• Retroperitoneal tumors
• Pancreatic cancer
• Study of liver and kidney transplant
• Vessel assessment in case of tumor invasion
• Bowel (without fat sat) :
 To check Surigical anastomose
 To demonstrate Abnormal wall thickening (Crohns disease)
 Detection and characterization stromal Tumor
 Body MRI at 3T
FS FIESTA : System Compatibility & Options
• Options :
 Acceleration type : ASSET and ARC
 Maximum acceleration : x2
 Seq, EDR, Fast, ZIP x512
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

FS FIESTA Yes Yes Yes yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
FS FIESTA Yes Yes Yes Yes Yes
 Body MRI
T2 FRFSE : T2 Fast Recovery Fast Spin Echo
Target :
• To create highly T2 weighted images with decreased acquisition times

Characteristics :
• FSE Family + Fast recovery
• Additional RF pulses are used after the last acquisition window to drive the
recovery of longitudinal magnetization
• The transverse magnetization is still present at the end of the echo train :
 This magnetization is refocused back into the longitudinal axis by applying
a –90° pulse
 During the time, the normal refocusing is occurring
 Body MRI
T2 FRFSE :
Characteristics :
ETL
α° α° α° α° α° α°
α/2° α/2°
RF
TR -α/2°

Z Z

xy xy
 Body MRI
T2 FRFSE : T2 Fast Recovery Fast Spin Echo
Characteristics : Mz
Parenchyma
Fat
Fluids
Signal
added
Without FRFSE

Time
TR medium TR long
Mz (2000 ms) (5000 ms)
Fat Parenchyma
Signal Fluids
added

With FRFSE

Time
TR medium (2000 ms)
+ FRFSE
 Body MRI
T2 FRFSE :
Characteristics :
• The Fast Recovery T2 enhancement establishes after several TR intervals, a
steady state longitudinal magnetization with a net enhancement of the long T2
components (like liquid structure)
• Allows very high T2 weighing with reduced TR and shorter acquisition time
• The sequence of choice for high-quality, high speed, and high-contrast T2-
weighted imaging
• With/without fat saturation (Fat Sat) and can be used with Respiratory triggering
 Body MRI
Acquisition Images
Single Echo

Double Echo

TE 60 ms TE 120 ms
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images : Parameters
Patient position : Supine Nex : 2
Coil : 8Ch Body Upper Phase FOV : 0.70
Plane : Axial Shim : Auto
Pulse sequence : FRFSE-XL Phase correction : Yes
Mode : 2D Flow Direction compensation : Slice
TE : 65 Sat : Fat Sat
Number of echoes : 1 Imaging options : FC, TRF, Fast, RT, FR
ETL : 19 USER CVS :
Bandwidth : 50.0 User CV7 : 1.0
FOV : 40 User CV19 : 1.0
Slice thickness : 5.0 Gating/Trigger :
Slice spacing : 1.0 Auto Trigger Type : Off
Freq : 416 Resp. Trigger Point : 30
Phase : 320 Resp. Trigger Window : 30
Freq DIR : R/L Resp. Inter-Seq Delay : Minimum
 Body MRI
T2 FRFSE : Advantages & Clinical Benefits
• Compared to FSE, FRFSE allows :
 shorter acquisition times or increased slice coverage
 High SNR
 Very high T2 weighing with reduced TR
• Fat sat : increases the lesion-to-liver contrast

T2 FRFSE : Challenges & Limitations

• FRFSE may not demonstrate the pathology with T1 relaxation effects
 Body MRI
T2 FRFSE : Clinical Use
• Detection and distinction of cysts and hemangiomas from malignant lesions
• Detection intrahepatic bile ducts dilatation
• MRCP
• Detection Prostate cancer
 Body MRI at 3T
T2 FRFSE : System Compatibility & Options
• Options :
 Acceleration type : ASSET and ARC
 Maximum acceleration : x2
 TRF, Fat sat, FC, ZIP 512, FR, RT
• Compatibility systems and coils :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

T2 FRFSE No Yes No yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
T2 FRFSE Yes Yes Yes Yes Yes
 Body MRI
T2 SSFSE : T2 Single Shot Fast Spin Echo
Target :
• To provide an excellent complement to T2-weighted abdominal imaging

Characteristics :
• FSE Family
• Uses an RF pulse design that allows for significantly shorter echo spaces (ESP)
• The minimum TE no longer equates to the ESP
• Acquisition time is equal to Echo Train duration (Echo space x ETL)

180° ETL
90°
 Body MRI
Characteristics :

K-space

128 + 8 256

• Uses a 0.5 NEX technique that acquires a data set within a single RF excitation
period
• The 0.5 NEX method in SSFSE contributes to edge blurring
 Body MRI
Characteristics :
• The TE selection determines the k-space filling technique :
 Linear Phase Encoding is used for short to medium range TEs
 Reverse Phase Encoding is used for long range TEs and minimizes SNR loss
since it acquires more echoes earlier in the echo train compared to Linear
Phase Encoding

K-space
Linear phase Reverse phase
encoding encoding
 Body MRI
Acquisition Images

2D SSFSE
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images : Parameters
Patient position : Supine Freq : 256
Coil : 8Ch Body Upper Phase : 192
Plane : Axial Freq DIR : R/L
Pulse sequence : Spin Echo Phase FOV : 1.0
Mode : 2D Shim : Auto
TE : 100 Phase correction : No
Number of echoes : 1 Imaging options : Fast, SS, ASSET
TR : Minimum Contrast : No
ETL : 21 USER CVS :
Bandwidth : 41.67 User CV2 : 200.0
FOV : 40 ASSET :
Slice thickness : 6.0 Slice Acceleration Factor : 1.0
Slice spacing : 1.0 Phase Acceleration Factor : 2.0
 Body MRI
T2 SSFSE : Advantages & Clinical Benefits
• SSFSE is well adapted to imaging non circulating liquid structures appaering
as a T2-weighted hypersignal (cholangio-IRM, Uro-IRM)
• Very high T2 weighing
• Reduction motion artifacts and imaging time (due to its rapidity)
• Used to scan uncooperative patients in short scan times
• Used for breath hold abdominal and cardiac imaging
• Used with long TE values (300-1300 ms) to image the gallbladder and biliary
tree

T2 SSFSE : Challenges & Limitations

• Given the length of echo train, the image obtained are highly T2-weighted,
since the majority of k-space lines are filled with long TE echoes
• The very long echo trains is a decay in SNR due to the weak signal from late
echoes and very high effective TE
• Low spatial resolution and blurring in the phase encoding direction
 Body MRI
T2 SSFSE : Clinical Use
• Biliary ducts (MRCP)
• Evaluation of the pancreatic parenchyma : extrapancreatic or inflammatory
process
• Kidney transplant
• Bowel : SSFSE is used to monitor filling during enteroclysis
 Body MRI at 3T
T2 SSFSE : System Compatibility & Options
• Options :
 Acceleration type : ASSET
 Maximum acceleration : x2
 Fast, ZIP 512, SS
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

T2 SSFSE Yes Yes Yes Yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
T2 SSFSE Yes Yes Yes Yes Yes
 Body MRI
DWI : Diffusion Weight Imaging
Target :
• Visualizes regions with a strong or low diffusion

Characteristics :
• DW-EPI sequence
• Exists a concentration difference between 2 compartments, and a
macroscopic flow can be observed between them
• The diffusion gradients can be applied in individual directions or combined and
applied in all directions
• D is the diffusion coefficient, it can be determined by the ratio of the flux and
the concentration gradient
 Body MRI
DWI : Diffusion Weighted Imaging
Characteristics :
• The simplest is to use a simple bipolar pulsed gradient experiment
• The static spins will produce no dephasing
• The moving spins will produce a dephasing :
 depending on the spin history during the time interval D between the
pulses

S(b) = S(0) exp (-b x ADC)

 Body MRI
DWI : Diffusion Weighted Imaging
Characteristics :
• About the b factor :
 The signal attenuation depends on both the diffusion coefficient (ADC)
and the gradient strength (b value)
 b is a value that includes all gradient effect (imaging gradients +
diffusion gradients) : the b value can be regarded as analogous as the TE
for the T2 weighting
 General rule : an increase of the b value increases the diffusion weighted
(the signal attenuation)
 Body MRI
DWI : Diffusion Weighted Imaging
Characteristics :
• About the ADC :
 ADC or apparent diffusion coefficient is a variable parameter (express in
mm2 /sec) that reflects the physical properties of the tissues
 The ADC value does not depend on the field strength of the magnet or on
the pulse sequence used (which is different for T1 or T2)
 The ADC obtained at different times in a given patient or in different
patients or in different hospitals can be compared
 In true diffusion images (ADC map) the contrast is opposite to diffusion-
weighted images :
 high signal corresponds to high, fast diffusion
 darkness corresponds to low, slow diffusion
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images

Liver STIR-DWI 20s scan

 Body MRI
Acquisition Images : Parameters
Patient position : Supine Shim : Auto
Coil : 8Ch Body Upper Phase correction : Yes
Plane : Oblique Imaging options : EPI, Diff, ASSET
Pulse sequence : Spin Echo USER CVS :
Mode : 2D User CV0 : 1.0
TE : Minimum DIFFUSION :
Number of echoes : 1 b value (sec/mm²) : 600
TR : 5750 Optimized TE : Yes
Number of shots : 1 Diffusion Directions : All
FOV : 40 Number of Diffusion Directions : 3
Slice thickness : 7.0 Number of T2 images : 1
Slice spacing : 0.0 Dual Spin Echo : On
Freq : 96 Recon All Images : On
Phase : 96 ASSET :
Freq DIR : R/L Slice Acceleration Factor : 1.0
Nex : 2.0 Phase Acceleration Factor : 2.0
Phase FOV : 1
 Body MRI
DWI : Advantages & Clinical Benefits
• Early detection and Characterization of focal lesions in the liver
• The echo planar sequence is generally prefered for its speed and limited the
motion artifacts (macroscopic)

DWI : Challenges & Limitations

• Artifacts :
 Image distortion (errors in gradient linearity)
 Ghost images (gradient instability)
• ADC map will be perturbed in this case, with measurement error
• Susceptibility artifact on diffusion imaging
 Body MRI
DWI : Clinical Use
• Early detection and Characterization of focal lesions in the liver
• Treatment’s efficiency and optimization
• Prognosis
• Oncology
 Liver metastases
 Focal nodular hyperplasia
 Hepatocellular carcinoma
 Benign hepatocellular lesions
 Prostate cancer
 Body MRI at 3T
DWI : System Compatibility & Options
• Options :
 Acceleration type : ASSET
 Maximum acceleration : x2
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

DWI Yes Yes Yes yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
DWI Yes Yes Yes Yes Yes
 Body MRI
3D FRFSE : 3D Fast Recovery Fast Spin Echo
Target :
• To enable high- resolution images for MR cholangiopancreatography (MRCP)
studies with either Respiratory Triggering or Breath-Held technique

Characteristics :
• Is built on the foundation of the 3D FSE pulse sequence + Fast Recovery
• Fast Recovery : To enhance the intensity of fluids that have long T2 relaxation
times, while using a shortened TR time
• Employs a partial Kz acquisition technique (75%) to improve breath-hold times
• Can acquire thin sliced acquisitions that can be reformatted into any plane.
• Applies a unique flip-angle scheme during the FSE readout that helps reach
pseudo steady-state at a faster rate
• During reconstruction, a special filter is applied to reduce T2 blurring and a new
slice apodization is used to increase resolution
 Body MRI
3D FRFSE : 3D Fast Recovery Fast Spin Echo
Characteristics :
• The reduced imaging times allow for breath hold acquisitions or free breathing
techniques acquired with Respiratory Gating/Triggering
• The 3D volume can be reformatted for better visualization of the bile ducts or
other anatomy
• Options :
 T2 prep : improves suppression of signal from background tissues
(Consider using T2 Prep combined with MRCP to increase TE and improve
T2 contrast)
• 3D FRFSE provides a MIP (Maximum Intensity Projection) at the beginning of the
series
 Body MRI
Respiratory triggering :
• Respiratory gating/triggering uses a respiratory bellows to reduce breathing
artifacts
• Real time breathing control unit :
 Triggering on breath out phases
 Supervision of breath-hold (stable)
 Body MRI
Respiratory triggering :
• The respiratory interval does not allow type in-values with the single shot
view ordering (the only available value is 1 RR)

FR
TR = 1 Interval
TR = 2 Intervals

30%

Respiratory
acquisition variation
 Body MRI
Respiratory triggering :

# Resp intervals : to determine the pulse

sequence repetition time, or Effective TR
Trigger point : Enter a Trigger Point value
between 10 and 50%
Trigger window : Enter a Trigger Window value
between 10 and 50%
Inter-Seq Delay : The time between each slice
location in the respiratory cycle
Resp rate : Click Update Rate to acquire an
update of the patient's current respiratory rate
in breaths per minute
 Body MRI
Acquisition Images
 Body MRI
Acquisition Images : Parameters
Patient position : Supine Phase FOV : 1
Coil : 8Ch Body Upper Shim : Auto
Plane : Oblique Phase correction : No
Pulse sequence : FRFSE-XL Imaging options : EDR, Fast, RT, ZIP 512, ZIP 2, ASSET,
FR, MRCP
Mode : 3D
Contrast : No
TE : 500-1200
Sat : Fat Sat
Number of echoes : 1
Gating/Trigger :
Bandwidth : 41.67
Auto Trigger Type : Off
FOV : 37
Resp. Trigger Point : 30
Slice thickness : 3.0
Resp. Trigger Window : 30
Location per slab : 44
Resp. Inter-Seq Delay : Minimum
Overlap Locations : 0
ASSET :
Freq : 416
Slice Acceleration Factor : 1.0
Phase : 256
Phase Acceleration Factor : 1.5
Freq DIR : S/I
Nex : 1
 Body MRI
3D FRFSE : Advantages & Clinical Benefits
• To enable high-resolution images for MRCP studies
• The reduced imaging times allow for breath hold acquisitions or free breathing
techniques acquired with Respiratory Gating/Triggering
• High SNR and CNR
• Non invasive alternative to the classic endoscopic techniques

3D FRFSE : Challenges & Limitations

• FRFSE may not demonstrate the pathology with T1 relaxation effects
 Body MRI
3D FRFSE : Clinical Use
• MRCP
 Diagnostic of a stenosis of the bilio digestive anastomosis
 Detection of a communication between a cystic lesion and the common
bile duct
 Detection of a calculi in intra-hepatic bile ducts
 Staging of the Klatskin’s tumor
 Body MRI at 3T
3D FRFSE : System Compatibility & Options
• Options :
 Acceleration type : ASSET
 Maximum acceleration : x2
 Fat sat, FC, ZIP 512, ZIP x2, FR, EDR, RT
• Compatibility systems :

Profile Ovation Brivo 355 Optima 360 Hde Hdi

3D FRFSE Yes Yes Yes yes Yes Yes

Optima 450- Discovery 3T Discovery

HDxt W 450 3T HDxt 750
3D FRFSE Yes Yes Yes Yes Yes
 Body MRI
Prostate Imaging :
T2 FRFSE :
• Sagittal : short sequence, just for volume measurements
• Axial : the sequence not to be missed
• Coronal

DWI : Axial diffusion with b600

LAVA : Dynamic T1 FS with contrast injection
 Body MRI
Prostate Imaging : Sagittal T2 FRFSE
 Body MRI
Prostate Imaging : Parameters (Sag T2 FRFSE)
Patient position : Supine Slice spacing : 1.0
Coil : 8 Ch Body Freq : 320
Plane : Sagittal Phase : 256
Pulse sequence : FRFSE-XL Freq direction : A/P
Mode : 2D Nex : 4
TE : 100 Shim : Auto
Number of echoes : 1 # of Acq Before Pause : 0
TR : 2280 Phase correction : No
ETL : 21 Imaging options : NPW, TRF, Fast, FR
Bandwidth : 31.25 USER CVS
FOV : 20 User CV20 : 0.0
Slice thickness : 4.0
 Body MRI
Prostate Imaging : Axial T2 FRFSE
 Body MRI
Prostate Imaging : Parameters (Ax T2 FRFSE)

Patient position : Supine Slice spacing : 1.0

Coil : 8 Ch Body Freq : 288
Plane : Oblique Phase : 256
Pulse sequence : FRFSE-XL Freq direction : A/P
Mode : 2D Nex : 4
TE : 100 # of Acq Before Pause : 0
Number of echoes : 1 Shim : Auto
TR : 2340 Phase correction : No
ETL : 25 Imaging options : NPW, TRF, Fast, FR
Bandwidth : 31.25 USER CVS
FOV : 20 User CV20 : 0.0
Slice thickness : 3.0
 Body MRI
Prostate Imaging : Coronal T2 FRFSE
 Body MRI
Prostate Imaging : Parameters (Cor T2 FRFSE)

Patient position : Supine Slice spacing : 1.0

Coil : 8 Ch Body Freq : 288
Plane : Oblique Phase : 256
Pulse sequence : FRFSE-XL Freq direction : S/I
Mode : 2D Nex : 4
TE : 100 # of Acq Before Pause : 0
Number of echoes : 1 Shim : Auto
TR : 2300 Phase correction : No
ETL : 23 Imaging options : NPW, TRF, Fast, FR
Bandwidth : 27.78 USER CVS
FOV : 20 User CV20 : 0.0
Slice thickness : 3.0
 Body MRI
Prostate Imaging : Axial DWI
 Body MRI
Prostate Imaging : Parameters (Ax DWI)
Patient position : Supine Phase FOV : 1.0
Coil : 8 Ch Body Shim : Auto
Plane : Axial Phase correction : Yes
Pulse sequence : Spin Echo Imaging options : EPI, Diff, ASSET
Mode : 2D USER CVS
TE : Minimum User CV0 : 1.0
TR : 4000-5000 DIFFUSION
Number of shots : 1 b Value : 600
FOV : 36 Optimized TE : Yes
Slice thickness : 5.0 Diffusion Directions : S/I
Slice spacing : 0.5 Number of Diffusion Directions : 1
Freq : 192 Number of T2 Images : 1
Phase : 192 Dual Spin Echo : On
Freq direction : R/L Recon All Images : On
Nex : 16
 Body MRI
Prostate Imaging : LAVA with FS
 Body MRI
Prostate Imaging : Parameters (LAVA with FS)
Patient position : Supine Shim : Auto
Coil : 8 Ch Body Phase correction : No
Plane : Oblique Imaging options : Fast, ZIP 512, ZIP x2, ASSET, Multi Phase
Pulse sequence : LAVA SAT : SPECIAL
Mode : 3D Contrast : Yes
Flip Angle : 15 MULTI PHASE
Bandwith : 62.50 # of acquisition : 1.0
FOV : 38 # of Phases : 10
Slice thickness : 4 Separate series : 1
Location per slab : 30 Delay after Acquisition without AV : 1
Freq : 240 ASSET
Phase : 240 Slice Acceleration factor : 1.0
Freq direction : R/L Phase Acceleration factor : 2.0
Phase FOV : 1.0
 Body MRI
Bowel protocol :
T2 SSFSE
T2/T1 FIESTA
LAVA
 Body MRI
Bowel protocol
MRI bowel examinations
• Oral contrast and fast MRI imaging sequences

Preparation :
• Fasting 5 hours before MRI examination
• Arrive 1 hours before examination
• Drinking evenly ever one hour
• Gown
• Venflon
• information regarding breathing
• Patient position : prone or supine
 Body MRI
Bowel protocol
Contrast Used :
• Oral contrast (reduces absorption in small bowel) :
 Sorbitol 55ml to 1 litre of water
 Manitol 500ml to 1.5 litres of water
 Prune juice 8 glasses(1st and last with husk)
 Klean-Prep
• Buscopan iv prior to contrast series
• Gadolinium :
 for visualisation of pathological changes in the bowel wall with LAVA or
LAVA XV series
 Body MRI
Bowel protocol
Sequences :
• Coronal SSFSE : to check the contrast has gone over to the large bowel
• 2D FIESTA and SSFSE (with/without fatsat) in coronal and axial plane pre
contrast
• LAVA or LAVA-XV (or LAVA-flex) mask pre contrast
• LAVA or LAVA-XV (or LAVA-flex) in coronal and/or axial post contrast
• 2D FIESTA, and SSFSE with water sat in coronal and axial plane
 Body MRI
Bowel protocol
Target :
• Evaluation of the gastrointestinal tract

Characteristics :
• Contrast resolution of MRI + negative intraluminal contrast agents (such as
water or iron oxides) and intravenous gadolinium
• Study functional and morphologic information with :
 SSFSE : T2 weighted images
 FIESTA : T2/T1 weighted images
• To provide an excellent depiction of the anatomy
• LAVA sequence is used after contrast to assess enhancing inflammatory or
malignant processes involving the bowel
 Body MRI
Acquisition Images : Pre contrast

SSFSE LAVA
 Body MRI
Acquisition Images : Post contrast

2D FIESTA
 Body MRI
Acquisition Images : post contrast

2D FIESTA FS SSFSE
 Body MRI
Acquisition Images : post contrast

Subtracted LAVA
 Body MRI
Bowel : Advantages & Clinical Benefits
• To provide morphologic and functional information
• Combines the advantages of ecellent soft tissue contrast, noninvasiveness,
and lack of ionizing radiation
• Other modalities, included conventional enteroclysis

Bowel : Challenges & Limitations

• Contrast stays in stomach
• Inhomogeneitic repartition of the contrast in stomach
• Patient has stomach cramp
• Contrast goes through small bowel unevenly
• Mask and contrast are different
• Patient feels sick especially in prone position
 Body MRI
Bowel protocol
Clinical Use :
• Crohns disease : 2D FIESTA and SSFSE and LAVA and LAVA-XV
• Surgical anastomose : 2D SSFSE (Dynamic thick slab)
• Stromal tumor : 2D FIESTA and LAVA (with Minip)
MR Modules
BODY BASIC

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